| Objective: In this study,the changes of intracranial pressure in patients with large area cerebral infarction were observed by continuous dynamic ICP monitoring.At the same time,in view of the large area cerebral infarction patients with ICP monitoring and non ICP monitoring of the prognosis for comparison,I hope to find ICP monitoring can significantly improve the prognosis of patients.Methords : 100 cases of Hebei North University Department of Neurosurgery,First Affiliated Hospital in 2013 September to 2015 July large area cerebral infarction patients,were randomly assigned to control group(50 cases)and experimental group(50 cases),to family members of patients obtain informed consent and signature.Control group was treated with routine conservative treatment,according to the CT/MRI and clinical symptoms predicted risk of cerebral hernia occurred,in order to determine whether surgical treatment.The experimental group take ICP monitoring.Conservative treatment,according to the ICP monitoring results indicate that the control of intracranial pressure is not satisfied with the situation to determine the timing of surgery,and then surgical treatment.Compared with the control group and the experimental group of conservative treatment in patients with dehydration drug dose.To observe the control group and the experimental group patients with GCS score changes,cure time,hospitalization days,mortality,disability rate,comparing the infection rates.ICP monitoring measurement and non ICP monitoring prognosis were compared in surgical treatment patients of large area cerebral infarction.Results: In the control group,19 cases were treated with conservative treatment,and 31 cases with surgery.In the experimental group,23 cases were treated by conservative treatment,27 cases were treated with operation.Conservative treatment of patients in the experimental group with mannitol use daily amount for 351.48+41.48 ml.Control group was 483.20+64.49 ml,of experimental group was significantly less than that of the control group,a statistically significant difference(t=6.48,P<0.05);mannitol of patients in the experimental group used time of 9.87+2.75 d and controls for the 14.78+3.64 d.In experimental group was significantly less than the patients in the control group,have statistical difference(t=5.27,P<0.05).Conservative treatment of patients,GCS scores of two groups of patients after admission respectively 7.62+1.32,8.10+1.51,two groups no significant difference(P>0.05)t=0.87;discharged patients,GCS score were 13.36+1.79,10.75+1.56,the experimental group was significantly higher than that of the control group,statistical difference(t=2.49,P<0.05).Conservative treatment of patients,two groups were cured respectively 14.67+2.35 d,21.13+3.53 d.Experimental group was lower than control group,two groups have significant difference(t=4.49,P<0.05).Two groups patients of hospitalization were 16.32+4.75 d,30.74+4.47 d.In experimental group was significantly lower than that of the control group,there was statistically significant difference(t=6.92,P<0.05).In the conservative treatment of patients,died in the experimental group,severe disability rate were 2 cases(8.70%),8 cases(34.78%),died in the control group,severe disability rate was in 3 cases(15.79%),9 cases(47.37%),the experimental group were significantly low than that of the control group,significant difference(?2 = 4.29,4.30,P<0.05).Conservative treatment of patients in the experimental group,the incidence of pulmonary infection was 5 cases(21.74%),the control group was 5 cases(26.32%),the experimental group was significantly less than the control group,there were significant differences(?2=3.47,P<0.05).The incidence of stress ulcer in the experimental group was 3 cases(13.04%),as control group 4 cases(21.05%),the experimental group was significantly less than the control group,there were significant differences(?2=3.27,P<0.05).There were 6 cases(26.09%)electrolyte disturbance in the experimental group,but the control group was 7 cases(36.84%),the experimental group was significantly less than the control group,there were significant differences(?2=7.34,P<0.05).The experimental group occurred abnormal renal function 2 cases(8.70%),the control group was 3 cases(15.79%),the experimental group was significantly less than the control group,there were significant differences(?2=5.49,P<0.05).Surgical treatment of the patients in the experimental group with mannitol use daily amount for 466.42+46.42 ml.Control group was 573.22+67.55 ml,of experimental group was significantly less than that of the control group,there was statistically significant difference(P<0.05);patients in control group were treated with mannitol time was 10.83+2.35 d.Control group was 15.74+3.57 d,of experimental group was significantly less than that of the control group,there was statistically significant difference(t=6.14,P<0.05).Surgical treatment of patients,GCS scores of two groups of patients after admission respectively 5.61+1.35,5.50+1.43,two groups there was no statistical difference(P > 0.05);discharged patients,GCS score were 12.32+1.74,9.79+1.43,the experimental group was significantly higher than that of the control group,there was statistically significant difference(t=5.39,P<0.05).Surgical treatment of patients,surgical treatment of patients with healing time were 16.61+2.89 d,23.25+3.77 d,the experimental group significantly lower than control group,two groups is statistically significant difference(P<0.05);surgical treatment of patients with hospital stay were 18.35+4.54 d,32.71+4.53 d.In experimental group was significantly lower than that of the control group,there was statistically significant difference(t=3.89,P<0.05).In patients with surgical treatment,died in the experimental group,severe disability rate were 4 cases(14.81%),14 cases(51.85%).While died in the control group,severe disability rate was 6 cases(19.35%),19 cases(61.29%),the experimental group were significantly lower than the control group,there was statistically significant difference(?2=3.22 and 2.37,P<0.05).The surgical treatment of patients,the incidence of pulmonary infection was 13 cases(48.15%)in the experimental group,the control group was 18 cases(58.06%),the experimental group was significantly less than the control group,there were significant differences(?2=3.73,P<0.05).The incidence of stress ulcer was 5 cases(18.52%)in the experimental group,the control group was 7 cases(22.58%),there were significant difference(?2=0.78,P<0.05).The incidence of electrolyte disturbance in the experimental group was 8 cases(29.63%),the control group was 15 cases(48.39%),there were significant difference(?2=0.69,P<0.05).The experimental group had 4 cases(14.81%)abnormal renal function,the control group was 6 cases(19.35%),the experimental group was significantly less than the control group,there were significant differences(?2=2.41,P<0.05).Conclusion: For patients with large area cerebral infarction,regardless of the conservative treatment or the surgery,after the intracranial pressure monitoring of patients due to treatment more targeted,the dosage of mannitol are more accurate and relatively low incidence of complications and clinical effect of satisfaction.1 In the treatment of large area cerebral infarction,continuous dynamic ICP monitoring is beneficial to the objective of the operation and the timing of the operation;2 ICP monitoring can improve the treatment of large area cerebral infarction,reduce the incidence of complications and mortality.3 The application of ICP monitoring in the treatment of large area cerebral infarction is worth popularizing. |
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